Credentialing

If you have been wondering whether Medicare still reimburses virtual therapy visits, the direct answer is yes. Physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (SLPs), and audiologists remain fully eligible to bill Medicare for Telehealth services through December 31, 2027. While political debates and temporary funding fights caused confusion early in the year, Congress officially resolved the status of therapy Telehealth. Here is what ha

It is one of the most frustrating notifications a private practice owner can receive. You submit a clean batch of claims, wait weeks for reimbursement, and instead open a Remittance Advice marked with a rejection code: Denied for Incorrect NPI. This specific rejection is incredibly common, yet completely avoidable. The most frustrating part is that an incorrect NPI claim denial often has absolutely nothing to do with you doing anything wrong clinically. Your NPI is real, your

When you first opened your private practice, your main goal was likely filling your schedule. To make that happen, you probably joined every insurance panel available in your area. Most therapists treat their panel list as a permanent setup: they take whatever insurance walks in the door and rarely look at their insurance contracts as a strategic business lever. But as your practice grows, taking every plan without a clear strategy can quietly cap your income. If you are work

There is an exciting point in a therapy practice owner's career when the waitlist grows too long, demand outpaces your schedule, and you realize it is time to expand. You decide to transition from a solo setup to a group practice model by hiring your first associate or licensed clinician. Many practice owners assume that because they are already in-network with insurance panels, bringing a new therapist on board simply means handing them a client roster and billing under the

You submit a batch of claims through your clearinghouse, check your dashboard a week later, and notice a handful are marked as pending. Another week passes, then a month, and nothing moves. The money sits in administrative limbo while your practice overhead keeps running. For solo and small group mental health, physical therapy, occupational therapy, and speech-language pathology practices, watching revenue freeze behind an insurance wall is one of the more demoralizing parts

By Danielle Wagar, CPES | Upstate Healthcare Admin Medicare enrollment is one of the most misunderstood processes in mental health private practice. Providers avoid it because it feels complicated. They delay it because they do not know where to start. And then they refer out every Medicare client for years — clients who could have been seen in their practice. This guide breaks down exactly how Medicare enrollment works for mental health providers. Who This Applies To Medicar

SimplePractice's free credentialing gets your applications submitted, but it will not build the billing system that gets you paid. Here is what is actually missing, and what to do about it.

By Danielle Wagar, CPES | Upstate Healthcare Admin Blue Cross Blue Shield is not a single insurance company. This is the thing most providers do not fully understand when they get credentialed with their local BCBS plan - and it is why BCBS claims can behave so differently depending on the patient in front of you. BCBS is a federation of 33 independent, locally operated member plans. When your patient has a BCBS plan from another state, the BlueCard Program governs how their

By Danielle Wagar, CPES | Upstate Healthcare Admin You signed a lease. You bought the furniture. You scheduled your first client at the new location. And then it hits you: none of your insurance panels actually know this address exists yet. Adding a new office location to your existing insurance contracts is one of those tasks that looks simple on the surface and turns into a 90-day project if you are not prepared. Claims get denied. Patients get billed incorrectly. Payers as

If you're thinking about leaving Alma, Headway, Grow Therapy, or Rula, the real question isn't credentialing. It's referrals. Here's how independent therapists build a referral pipeline they own and protect their caseload for good.